Activity Based Costing in Healthcare: A UK Case Study

he reduction of public funding and the emphasis on performance measurement in public services have influenced the management and accounting practices of many healthcare systems. The pressures have led many managers to search for management tools, often derived from the private sector, in the attempt to rationalize their use of resources. Activity Based Costing (ABC) is one of these techniques which has gained considerable attention both from practitioners and researchers. This paper examines the case of a UK healthcare organization which implemented ABC to provide sharper cost information for control and decision making. The paper is a longitudinal study of an accounting application which provides insights into the process of adoption and enactment of costing innovation in healthcare. ealthcare systems, internationally, face pressures to deliver cost efficient care in the face of escalating demands. These pressures have led to many initiatives to improve the management and efficiency of healthcare delivery. This paper examines the trajectory—from initial idea to implementation—of the adoption of activity based costing (ABC) to improve efficiency by one healthcare organization. The healthcare organization which is discussed in this paper is a blood transfusion service, part of the UKs National Health Service. This study reveals the challenges, the pitfalls and the problems of adopting a costing technology which is radically different from previous practices in a healthcare setting. RESEARCH CONTEXT The UK’s blood transfusion service is currently organized into four regional centers for the collection and distribution of blood (Varney & Guest, 2003). The role of these centers in the healthcare system is crucial and their management is complex from the ‘raw material’ procurement phase through to final use. The UK’s transfusion services rely on voluntary donors, who donate their blood up to three times a year. Though this

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